This invention relates to an apparatus and methods for determining the course of a patient's illness and response to treatment. More particularly, this invention provides a mechanism for analyzing for presentation in graphical form information concerning the patient's symptoms, emotional state, physical findings, test results and treatments. The invention has application in the fields of medicine, psychiatry, surgery, obstetrics, pediatrics, and other medical specialties.
In general, written records for medical and for psychiatric patients have been used to record symptoms as they are reported, physical findings as they are observed, test results as they are measured and treatments as they are instituted. Early medical record systems relied solely on paper documentation. Typically, medical personnel recorded observations or treatments by hand on preprinted forms for storage on clipboards, in binders or in folders. Certain reports, such as lab write-ups, may have been recorded in typewritten form. More recently, medical records have been stored in computer databases for on-line access and display in text format and, to a limited degree, graphical format.
In this regard, reference may be made to the book by Jesse B. Hall, M.D., Gregory A. Schmidt, M.D., & Lawrence D. H. Wood, M.D., eds, Principles of Critical Care, McGraw-Hill, Inc, New York, 1992. The teachings of Chapter 41, "Computer Applications" by Alan H Morris, M.D. and Reed M.Gardner, Ph.D. at pages 500-514 are incorporated herein by reference. Reference may be made to the book by Carol L. Lake, M.D., Clinical Monitoring, W. B. Saunders Co., Philadelphia, 1990. The teachings of Chapter 12, "Patient Data Management Systems" by John W. Hoyt, M.D. and Harry Comerchero at pages 433-451 are incorporated herein by reference. Reference may be made to the book by J. Andrew Billings, M.D. & John D. Stoeckle, M.D., The Clinical Encounter, Year Book Medical Publishers, Inc. Chicago, 1989. The teachings of Chapter 6, "Recording" at pages 81-91 are incorporated herein by reference. Reference may be made to the book by Lawrence L. Weed, M.D., Medical Records, Medical Education, and Patient Care, The Press of Case Western Reserve University, Cleveland, 1969. The teachings of Chapter 5, "The Progress Notes" at pages 49-60 and chapter 6, "Flow Sheets" at pages 61-82 are incorporated herein by reference.
Reference may also be made to the book by James D. Foley, Andries van Dam, Steven K. Feiger, and John F Hughes, Computer Graphics: Principles and Practice, 2nd ed., Addison-Wesley Publishing Company, Inc., Reading 1992. The teachings of Chapter 2, at pages 25-66, Chapter 3 at pages 67-144, and chapter 7 at pages 285-346 are incorporated herein by reference.
In conventional medical and psychiatric record systems, information is usually presented in one of a small number of forms: prose, flowsheet, time plot. Hand written prose is the form most often used to record and present patient information. Sometimes word processing or automated data processing techniques are used to make the text more legible and accessible.
Patient information that is largely numeric is sometimes presented in flowsheets, also referred to as spreadsheets by some. Each flowsheet column corresponds to succeeding dates or times. Each flowsheet row is reserved to present a certain type of data such as temperature or blood pressure or fluids given. Alternatively, rows may be used for times and columns for types of data.
Sometimes automated data processing techniques are used to make the values easier to enter and more legible. Conventional time plots (graphs) are occasionally used in permanent patient records to present the results of a specific laboratory test over the course of an illness. The test value is plotted along a linear vertical scale and time is plotted along a linear horizontal scale. Such plots are more commonly used for instantaneous display of electrocardiograms and blood pressure for patients in an intensive care unit, in an operating room, or in a recovery room. These plots show a small number of critical values for a short period of time on a linear scale and are not usually part of the permanent record.
A problem presented by these prior art systems is that the presentation of patient information in prose form makes it difficult to apprehend the course of a patient's disease, or the course of a patient's treatment. Hand written prose is often difficult to read. Typing may improve legibility, but it does not organize the information so that the human eye may perceive a pattern. Rather, prose presentation requires the eye and the mind to work continuously to pick and sort out patterns of disease and treatment from text ordered only by the time it happened to be recorded.
Further, because a long list of numbers only draws the eye and the mind along in a straight line, the prior art systems using the flowsheet form also make it difficult to apprehend the course of patient's disease, or the course of patient's treatment. Moreover, the numbers themselves are surrounded by other numbers. The upward or downward trend, the value to value variability is not directly perceived.
Presenting patient information in conventional time plots makes it difficult to apprehend the patient's overall condition. Conventional time plots do make it possible for the eye to follow the trends and variations of a given type of information. However, prior methods only present one or a small number of plots to be viewed together and linear scaling makes it difficult to perceive the trends over the last few days in the same glance as the trends over the years of the patient's life.
An object of this invention, accordingly, is to provide improved methods and apparatus for analysis and presentation of patient information which remedies the above mentioned drawbacks. More particularly, and object of the invention is to provide a mechanism for analyzing for presentation in graphical form patient information so that it can be quickly and accurately perceived by physicians, nurses, and other medical personnel.
A further object of this invention is to provide such a mechanism which can operate on a wide variety of patient information including, but not limited to, physical findings, psychiatric findings, laboratory test results, and various treatments.
Yet another object of this invention is to provide methods and apparatus for analyzing for presentation in graphical format patient information that encompasses long periods of time so that chronic disease conditions and the results of treatments can be quickly and accurately perceived.
Still another object of this invention is to provide such methods and apparatus that can serve as components of an on-line patient information system.
A still further object of this invention is to provide for the analysis and presentation of patient information in graphical form and, thereby, to facilitate the exchange of medical information around the world by minimizing language differences.